Table 2.

Cultures of workplace support

Medical versus biopsychosocial approaches to episodic disability support
“Because our third-party providers have that [diagnosis], in most cases, it’s a much smoother transition…. I find even return to work recommendations are more meaningful because they have the diagnosis. As you know, the most important thing is that people are properly diagnosed.” (Resp 8, DM, utilities)  “Insurance companies want medical documentation and…disability plans expect you, that if [person X] is going to be off for more than four months, she better be seeing a specialist. In other words, she better show some initiative to improve…” (Resp 21, union representative, healthcare)	“We only gather medical information, or I get involved in about 25% of cases. Seventy five percent of cases do not involve a medical practitioner at all for six months—up till they go to long-term disability. We would sort of describe that as a continuous improvement thing where we’re trying to accommodate people as opposed to manage their diagnosis, which is a complete and utter waste of time…. You can’t explain everything by medicine… and you need to find some way to be fleet of foot and manage these because, if you don’t, they go sour very quickly.” (Resp 9, medical director, business/finance) “I think it’s the biggest single challenge and opportunity that we’ve got… A lot of people don’t even have a reliable healthcare provider so this whole thing of ‘get a sick note after five days, what are your limitations’—it’s really a fiction…. We have so little practical preparation for these health professionals to play the role they need to play.” (Resp 7, worker advocate, public service)
Promoting fairness and transparency
“Supervisors aren’t supposed to just make a side deal with the workers…. Because then you’re sort of making side deals with everybody, but nothing is really documented. It’s super important that, if there’s a concern, that it go forward to either to the HR or health and safety individual.” (Resp 13, DM, manufacturing)	“It’s impossible, I think, to capture in any sort of policies or procedure the degree of nuance and individualization and the contextual analysis that you have to bring to bear on this sort of stuff. It isn’t a one-stop. There isn’t the one easy answer. There isn’t the one fix. It has to be really individually tailored for everybody.” (Resp 3, labour lawyer representing workers)
Return on Investment (ROI) versus Value on Investment (VOI)
“Everyone is interested in ROI and we’re trying to talk to them about value on investment instead. The VOI is really important…. My feeling is, if you do the right thing, the numbers will follow. I think if more organizations looked at it that way, they would also be looking at protecting psychological health and taking care of their employees. I think there is a shift that is happening. I’m just not sure that we are there yet.” (Resp 20, DM, consulting firm)